Treinamento resistido em dupla tarefa: estudo piloto de um ensaio clínico randomizado com pessoas idosas com Diabetes Mellitus tipo 2

Abstract

Introduction: The aging process is associated with chronic subclinical systemic inflammation (inflammaging), making older adults more susceptible to type 2 diabetes mellitus (T2DM), and when combined with a sedentary lifestyle, this risk becomes even higher. Similarly, cortical and subcortical brain atrophy has been associated with T2DM, and the brain regions most influenced by insulin resistance are the hypothalamus and the hippocampus—areas directly related to the development of cognitive declines and dementias. These effects can be observed from the earliest stages of glycemic dysfunction, independent of the presence or absence of micro- or macrovascular complications, whereas regular physical exercise counteracts this effect by preserving brain volume. Thus, the practice of physical exercise is essential for healthy aging, the maintenance of intrinsic capacity and functional ability, and particularly for preventing age-related cognitive decline and the clinical worsening of T2DM. Recent evidence has shown that simultaneous cognitive tasks and exercise (dual-task) improve cognitive function in healthy older adults. However, the benefits of this approach, especially when associated with resistance exercise, remain underexplored in the T2DM population. Objective: To conduct a pilot study of a single-blind, randomized, controlled trial evaluating the influence of a dual-task resistance exercise (ER-DT) intervention protocol on the cognitive performance, functional capacity, and glycemic control of older adults with type 2 diabetes mellitus, compared to the impacts of resistance exercise performed in isolation (ER) and usual care (Control Group). Methodology: This was a single-blind, randomized, controlled pilot trial. Fifteen participants (mean age: 67.67 ± 5.84 years) were randomly assigned to three groups: ER-DT (n=5), ER (n=5), and CON (n=5). The interventions lasted for 12 weeks, with three weekly 60-minute sessions. Data analyses followed the intention-to-treat principle and used mixed linear models with bootstrap techniques for greater statistical). The primary outcome of interest was cognitive performance, and secondary outcomes included functional capacity and glycemic control in older adults with T2DM. Results and Discussion: Cognitive function, assessed by the Mini-Mental State Examination (MMSE), showed significant improvement in the ER group (Δ = 1.62; 95% CI [0.10; 3.22]; p = 0.004) and a decline in the control group (Δ = -2.26; 95% CI [-3.80; -0.64]). Performance on the Trail Making Test A significantly improved in the ER-DT group (Δ = -5.80 seconds; 95% CI [-8.90; -2.70]; p = 0.003), indicating increased processing speed. In the Verbal Fluency Test, the ER-DT group recalled a greater number of words (Δ = 3.42 words; 95% CI [1.10; 5.50]; p = 0.008), suggesting improvements in executive function and semantic memory. Reaction time in the Flanker Test was significantly longer in the control group (Δ = 86.16 ms; 95% CI [21.2; 147.0]; p = 0.006). Regarding metabolic parameters, waist circumference significantly increased in the control group (Δ = 9.70 cm; 95% CI [7.20; 12.20]; p < 0.001), while no significant changes were observed in the ER and ER-DT groups. No significant differences were observed in HbA1c (p = 0.213). Conclusion: The results of this pilot study provide initial evidence regarding the impact of the ER-DT protocol on cognitive performance, inflammatory profile, and glycemic control in older adults with T2DM. The pilot study also ensures the safety of the intervention and participant adherence. Despite methodological limitations, the findings highlight promising trends, as well as safety and feasibility, which justify further investigation.